Mo. faces tough emergency contraception issue

Saturday, January 14, 2006

JEFFERSON CITY, Mo. -- In some of his pharmacies, Matt Hartwig doesn't even stock emergency contraception because so few women ask for it that it would go out of date on the shelf. But Hartwig has filled prescriptions for the morning-after pill in the past and is willing to in the future.

Yet Hartwig doesn't want the government to tell him he must fill the prescription. Nor does he want a law specifically giving him the right not to do so.

"We already have that right, we don't need legislation for that," he said. "Right now there is nothing that mandates us to fill a prescription. We can refuse to fill any prescription we want."

But Gov. Matt Blunt and some lawmakers on both sides of the abortion issue believe the state needs to step in.

Blunt and other abortion opponents want an explicit right not to fill prescriptions to prevent pharmacies from firing or disciplining pharmacists who refuse to provide the morning after pill.

Abortion rights supporters, meanwhile, want to follow Illinois and require pharmacies to supply the morning-after pill.

Since 2003, the federal Food and Drug Administration has been considering whether the morning-after pill Plan B should be available without a prescription to everyone, to women 18 and older or to no one. Almost three years later, four states have already passed laws allowing pharmacists to refuse to fill prescriptions when they have moral objections to the drug. Illinois has taken the opposite tack, requiring its pharmacies that provide birth control to also fill prescriptions for the morning-after pill.

The morning-after pill is designed to give a super dose of standard oral birth control taken 72 hours after unprotected sex.

Hartwig, who owns several western Missouri pharmacies and is president of the Missouri Pharmacy Association, said the problem with legislation is that there's no way to know exactly how emergency contraception prevents pregnancy. The morning-after pill can prevent ovulation and can prevent sperm from fertilizing an egg in the fallopian tubes, but it can also prevent a fertilized egg from becoming attached to the uterus.

"We don't know where in the fertilization process Plan B is working," he said. "No one really knows, but it's really the same case for regular oral contraceptives. If a woman misses one or two days of oral contraceptives, they're told to take one in the morning and one at night to get caught up."

Lawmakers on both sides of the abortion divide have rushed to shore up this doubt.

Sen. Jason Crowell said the uncertainty about what precisely happens when emergency contraception is used makes it reasonable for some pharmacists to believe the morning-after pill causes an abortion with the possibility that it prevents a fertilized egg from being carried to term.

"In some people's minds, if you won't fill the prescription, than you can't work as a pharmacist," said Crowell, R-Cape Girardeau. "We would never do that to a doctor, we would never do that to a nurse. Why someone would think that it's right to do that to a pharmacist kind of shocks me."

Sen. Joan Bray said she is stunned a doctor or nurse would say preventing a fertilized egg from attaching to the uterus constitutes an abortion. Because the scientific community has largely rejected this as a definition of an abortion, she said, a woman seeking a prescription for the morning-after pill should not be forced to seek out a pharmacist willing to fill it.

"If you can't be what your profession expects you to be, don't be that profession, find another line of work," said Bray, D-St. Louis. "Where do we stop with pharmacists playing doctor?"

Arkansas, Georgia, Mississippi and South Dakota have state laws allowing pharmacists to refuse to fill prescriptions for the morning-after pill while legislatures in Alaska, California, Hawaii, Maine and New Mexico have moved to make the drug available without a prescription.

Hartwig said communication, not politics, is going to do more to balance the rights of pharmacists and women seeking emergency contraception.

"If a physician wants something like that dispensed, they should find someone that will dispense it," he said. "Then, he can refer patients directly to a pharmacist who would dispense the prescription."

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